What are the 7 markers used to test liver function?
- alanine transaminase (ALT)
- aspartate aminotransferase (AST)
- alkaline phosphatase (ALP)
- Gamma-glutamyltransferase (GGT)
- Bilrubin
- Albumin
- Prothrombin time (PT)
Which 4 markers are used to distinguish between hepatocellular damage and cholestasis?
- ALT, AST, ALP and GGT
Which 3 markers are used to assess livers synthetic function?
- Bilirubin, albumin, Prothrombin time
What is ALT a good marker of?
hepatocellular injury
What is ALP a good marker of?
a good indirect marker of cholestasis
How many times the normal value of ALT is pathological?
x10
How many times the normal value of ALP is pathological?
x3
What does a raised ALP and GGT suggest?
Cholestasis (reduction or stoppage of bile flow)
Biliary epithelial damage and bile flow obstruction
Could also be raised due to alcohol and drugs (phenytoin)
What does a raised ALP and normal GGT suggest?
non-hepatobiliary pathology
- could be anything that leads to bone break down as bone contains ALP (bony metastases, Vit D deficiency, bone fracture)
What does it suggest if ALT is raised much more than ALP and vice versa?
ALT > ALP - hepatocellular pattern
ALP > ALT - cholestatic pattern
The common causes of isolated jaundice (LFT normal)?
- Gilberts syndrome
- Haemolysis
Jaundice + normal urine + normal stools - where is the problem?
Pre-hepatic cause
Jaundice + dark urine + normal stools - where is the problem?
Hepatic cause
Jaundice + dark urine + pale stools - where is the problem?
Post-hepatic cause (obstructive)
Name the 3 causes of unconjugated hyperbilirubinaemia?
Haemolysis (anaemia)
Impaired hepatic uptake (drugs, congestive HF)
Impaired conjugation (gilberts)
Name the 2 causes of conjugated hyperbilirubinaemia?
Hepatocellular injury
Cholestasis
What are the 3 main causes of a fall in albumin?
- liver disease resulting in a decreased production of albumin (cirrhosis)
- inflammation triggers an acute phase response, which temporarily decreases the production of albumin
- Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome
what does the ratio between ALT/AST show?
ALT > AST chronic liver disease
AST> ALT liver cirrhosis and acute alcoholic hepatitis
Look at the following presentation and choose between acute hepatocellular damage, chronic hepatocellular damage and cholestasis
ALT - Very raised
ALP - Normal or S.raised
GGT - Normal or S. raised
Bilirubin - Very raised
Actute hepatocellualr damage
Look at the following presentation and choose between acute hepatocellular damage, chronic hepatocellular damage and cholestasis
ALT - Normal or S.raised
ALP - Normal or S.raised
GGT - Normal or S. raised
Bilirubin - Normal or S.raised
Chronic hepatocellular damage
Look at the following presentation and choose between acute hepatocellular damage, chronic hepatocellular damage and cholestasis
ALT - Normal or S.raised
ALP - V.raised
GGT - V. raised
Bilirubin - V.raised
Cholestatsis
What are the 3 causes of acute hepatocellular injury?
Poisoning
Infection (hep A or B)
Liver ischaemia
What are the 4 causes of chronic hepatocellular injury?
Alcoholic fatty liver disease
Non-alcoholic fatty liver disease
Chronic infection (Hep B or C)
Primary biliary cirrhosis
Less common:
- Alpha 1 antitrypsin deficiency
- Wilsons disease
- Haemochromatosis
